41q

Haematology

Drug induced anemia

RBCS

item

Drug induced anemia

Inumerate drug induce anemia
anemia
iron deficiency anemia
proton pump inhibitors , H2 blockers ,

drugs

iron deficiency
HCL

absorbtion

iron

achlorhydria

iron deficiency
iron

hemorrhage

over dose of anticoagulant

anticoagulant

bleeding
deficiency anemia

B6 metabolism
methotrexate

absorption

Inh
drugs

sideroblastic
folic acid

sulphonamide

antis

B12 & folic acid

activation

antibiotic antiepileptic antidiabetic antithyroid

aspirin , antimalarial or sulphonamides

anemia

and antiepileptic

Bone marrow failure

G6PD

hemolytic anemia
hemolysis

iron parentral
amphotercin

alpha methyl dopa

PNH

induce autoimmune hemolytic actions

B
by themselves can induce autoimmune hemolytic anemia

antigen
RBCs

incomplete antigen
antigen

immune system

HAptin

penicillin

antigen

Mention mechanism of anemia in the following disease

Liver cell failure
Leukemia
Renal failure

RBCs

Coagulation or homeostasis
coagulation or homeostasis
Mechanism by which the body stops bleeding

Mechanism

bleeding
hemorrhage

hemorrhage
platlets

BloodVessels

clotting system

BloodVessel
vasoconstriction

vasoconstriction

blood vessels

activated

BloodVessel

blood clotting system

stasis

bleeding

vasoconstriction
injury

sympathetic fibers nerve supply

injury

blood vessels

injury

Local axonal reflex

reflex vasoconstriction

irritation

serotonin

serotonin & Local axonal reflex

VC

response

platelets
platlets

megakryocytes

megakryocytes

BoneMarrow

budding
alpha and dense

granules

nucleas

Platelets

megakryocytes

granules
5

11
platelets

011

111

platlets

which means
Platelets

Platelets

wall of blood vessels

factor 8

VWbrandfactor

adhesions
wall

Injury

Glycoprotein receptor

receptor

endothelium
platelet
Platelets

platlet aggregatons

step

GP2b/3a

protein
fibrin

Prostaglandin
TXA2

ThromboxaneA2

aggregations

Prostaglandin

antiplatlet

aspirin
platelets aggregations

granules

granules

platelets

step of secretions

serotonin

VC

serotonin

aggregations
coagulation factors

clot

activation

wall

contents

ADP

Platelets

platelet factor 3

secretions

blood clot
clot

step

retractozyme
retractozyme
function of platelet

coagulation
not all of them

liver

factor 13

11 7 9 2
activation

1792

liver

not activated

endothelium

in contact with collagen

11 activate 7

7 activate

11

injury
activate 11

liver

activation

is lined be endothelium

endothelium

ca
vit k

?
collagen

coagulation

12

CoagulationFactors

blood vessels

endothelium

collagen

12 activate

collagen
calcium + Platelets factor 3 & 8
intrinsic pathway
component

3 9

11

3 9

tissues

Extrinsic pathway

not present in blood tissue factor

pathway

11

trauma
3

extrinsic

brain , prostate , placenta

very rich in tissue factor

common pathway
fibrinogen into

thrombin

pathway 2
prothrombin to thrombin
RBCs wbcs and platelet

tissue of the body

11
11

common pathway
fibrin

intrinsic and extrinsic and common pathway

fibrin

Anticoagulant system
anti- coagulation system

coagulation system

balamce
blood

extend

balance

thrombus

coagulation system
thrombus

anti coagulation

anti coagulant
vasoconstriction

antagonize

endothelium

vasodilatation

platelets

intrinsic pathway

extrinsic pathway

anti coagulation

prostacyclin

wall of bv
collagen

vessels

inhibition

endothelium

activation

endothelium

tissue factor inhibitor

endothelium

antithromibn 3

endothelium

common pathway

pathway 3

endothelium

fibrinolysis

tPA

anti coagulant
anti coagulant

coagulation factors

coagulation factor

liver

VIT K

liver

anti coagulant

VIT K

protein C & S

balance

anticoagulation factor

activated

factor activated
injury

liver

active factor

active

Basics
general rules

General Rules
coagulation
blood vessels , Platelets or coagulation factors

disease

etiology

purpra

blood vessels or Platelets

raised ,

color

red spots

Clinical picture
petechaie

red then brown the disappear

change

color changes
Platelets

bv
, bleeding gums perifollicular hemorrhage
hair follicles
without

spontenous

external hemorrhage
hemorrhage
hemorrhage

perifollicular hemorrhage epistaxis,

cerebral hemorrhage
Hemorhhage

petechie

anemia

trauma


disease

picture

ecchymosis and hematoma

anemia

coagulation

raised

ecchymosis

hemotpysis hematuria whatever

hematoma

petchiea more than 3 ml

external hemorrhage
internal hemorrhage

Internal hemorrhage

hemophilia

coagulation congenital

joint and muscles

hemoarthrosis

joint

congenital

hemorrhage

external and internal hemorrhage

hemorrhage

congenital

trauma

bleeding

hemorrhage

cutting umbilical cord

umbilical cord

detected

supplying baby
cp

bv and Platelets

epistaxis

hemoptysis and bleeding gum

clinically

overlap

bv and Platelets

hematoma

investigations not cp

petechie

hematologist

Investigations

blood vessels , coagulation or platelets or anatomical

ICU
tube

Open heart

ICU

011

pericardium

tube

011
medical
medical

suture

medical or surgical

complications
investigations

blood vessels , coagulation or platelets

bleeding time

1
bleeding time

=D
bleeding

platelet

same effect

Bleeding
blood vessels or Platelets
abnormal

prolonged
platelet count function

bleeding time

2- 4 minuits

blood vessels or Platelets

blood vessels

clotting time

clotting time

prolonged

bleeding time

in 5 10 minuits

surgical

anatomical ,

7 clotting time

coagulation

9 bleeding time
bV

2 bed side test

Platelets

blood vessels

Platelets

11
common

extrinsic

Intrinsic

collagen
7

coagulation

PTT

, , 7 activate 11

, 11 activate 12 activate 12

fibrinogen into fibrin

thrombin

coagulation

PT

PTT

collagen

intrinsic

ptt

3 9

blood clot

11

extrinsic and common

PT

3 9

brain
extrinsic

thrombin

prothrombin to thrombin

clotting time
PT abnormal

ptt

PT normal
common pathway

, intrinsic

clotting

PTT abnormal

Abnormal

PT normal

PTT abnormal

12

1221127
11
deficiency

test normal

11
50 mg

mg 11

ratio between PT
brain tissue
rabit

second 16
rabit

intrinsic

12

PT

rabit

activate

15 seconds

intrinsic

11

pathway

pathway

extrinsic

test

11 activate
blood clot

tissue factor

fibrinogen into fibrin

abnormal

11

PT

brain placenta and prostate

11

activate

30 seconds

brain tissue of rabbit

11

pathway

prothrombin to thrombin

intrinsic and common

pt and ptt

INR
12

PT

variable tissue factor

content

rabbit
brain tissue

tissue

brain tissue
10 PT

Tissue

11

11 PT
Tissue variable from one to another

41

Brain tissue

10

ratio

16

32

PT
12

20
2 INR

2
PT control

PT

=D 125 INR
2-3 times

PTT

INR

12

INR 2

3
20

PT

heparin

:D

Adjust heparin dose

PTT

Anticoagulant
fibrinogen le fibrin

PT

thrombin

normal

tesathrombin
fibrinogen bs
obsolete

clot

hess capillary fragilty test

Treatment
Bleeding tendency
Avoid trauma , avoid injury
Avoid unnecessary surgeries
Avoid aspirin

Vascular purpra
vascular purpra

blood vessels

Platelets

blood vessels

vascular purpra and platelet purpra

congenital or acquired

Platelets

purpra

blood vessels

vascular purpra

congenital
congenital weakness in wall of blood
features
blood vessels dilated

ehler danlos and marfan syndrome

ehler

telengectasia
vasoconstriction in response to trauma
GIT hemorrhage

marfan

typical

vessels

herediatary hemorrhagic telengectasia

blood vessels
response to trauma is vasoconstriction

Acquired
I M
blood vessels
vit c deficnecy

scurvy

acquired

hypertension
collagen

acquired

Mechanical

Mesenchymal weakness

scurvy , perifollicular
old age

hemorrhage
steroid ttt and cushing

fast food
I
plague

Infections

SLE

collagen disease

Inflammation

henoch schonlein purpura

Immunological

very common in female

Idiopathic

Henoch schonlein purpura

Henoch schonlein purpura
Antibodies

rheumatic fever

upper airway infection

story of

immune complex

blood

blood vessels
antigen

heart

Antibodies

complex

against organism

Rheumatic fever

rheumatic fever

vasculitis
IgA
it doesnt take that

11 3

Henoch schonlein

IgG& IgM

Henoch schonlein

vessels

Rheumatic fever

Rheumatic fever
long time

Clinical picture
3

petechie

Purpra

blood vessels

buttocks

color changes

cerebral hemorrhage

internal and external hemorrhage

external hemorrhage
periarticular
arthritis

Internal and external hemorrhage

internal hemorrhage

D.D of intusseption

red hot tender

joint

GIT
joint

hemorrhage

rheumatic fever
spontenous without trauma
glomeruli

blood vessels

glomerulonephritis

hemorrhage

characterstic

nephritic syndrome and renal failure

Investigations
Bleeding time
Normal PT,PTT, Platelet count
RBCs cast in urine
specific

Treatment
corticosteroids
Platelets

blood vessels

Platelets defect
3
Thrombocytopenia
Thromboasthenia
Thromobcytosis
decrease in Platelets count

Thrombocytopenia

defect in function

Thromboasthenia
Thromobcytosis

212111

1112111

Platelets

Thrombocytopenia
Platelets

count

Platelets

1112111
Platelets

Platelets
surgery

pooling

Bone marrow failure

Platelets < 60.000

enough above 50.000

1112111

512111
dilution

712111
Platelets

minor surgery

destruction

1112111

production

Platelets
Platelets

production

production

drugs

pancytopenia

b12 & Folic acid deficiency

diuretic

immunological

splenomegaly

destruction

autoimmune or alloimmune
against

AB

autoimmune

thiazide

incompatible blood transfusion

antibodies

immunological
AB

Alloimmune

my own platelets
evan syndrome , alpha methyl dopa ,
Platelets

ITP
AB

warm hemolytic anemia Autoimmune

%9 0

allergy
platelets

Heparin induced thrombocytponea

IgG

heparin

population

Thrombosis

thrombosis

alpha methyl dopa , ITP and evan syndrome

thrombotic thrombocytopenic purpra , hemolytic uremic syndrome
destruction
BM

DIC

AUtoimmunie and alloimmune

increase destruction

destruction

reticulcytes

decr prod

BM
platlets

destruction

decrease productin

Platelets

platelets

incr or dec

BM

low Platelets count

decrease production

pooling
211 at any moment Platlet

pooling
311

311
splenomegaly

incr or decr

pooling

spleen

Platelets

211
211

spleen

blood

91

spleen

splenomegaly

91
Platelets

platelets

131

spelnomegaly

hypothermia

111

count actually normally

hypothermia

pooling

spleen

we have no idea

splenomegaly or hypothermia

spleen

pooling

dilution
fresh flood
dilution of

Platelets

Platelets

5
ca

platelet thrombocytopenia

2 units of platelets

massive blood transfusion

plaltlet
platelets

dilution of platelets

massive blood transfusion

Causes of thrombocytopenia
ITP

ITP Idiopathic thrombocytopenic purpra

idiopathic
Budding of megakayocytes
complex

BM
receptors

ITP
IgG

ITP

IgG Antibodies

macrophage

spleen
platelets

IgG

Platelets

macrophage

Platelets

budding

AB

Clinical picture
CP
petechia <3 ml doesnt blanch , not raised
cerebral hemorrhage

external hemorrhage and internal hemorrhage

spontenous

children

acute

within 3

acute and chronic ITP

specific

spontenous remission
mild

mild

severe thrombocytopenia

middle age

females

remission and excarebation

chronic ITP
Mild :D

month

thrombocytopenia

remission and exacerbation

Investigation
Bleeding time
Platelets count
normal clotting time PT ,PTT
IgG
Specific inv

megakaryocytes wth defective budding

Treatment
Avoid trauma , avoid injury
Avoid unnecessary surgeries
corticosteroids

mild hemorrhage
cerebral hemorrhage
Antibodies

Platelets

bleeding

temporary we are just buying time

you are just buying time

receptors of macrophages

permenant treatment
danazole

fever

Ab

ITP
lymphoma and leukemia

pooling

aplastic anemia

spleen

splenomegaly or Lymphadenopathy or
IgG

Plasma pharesis
splenectomy

budding

Ab

Antibodies

cyclosporine

ITP

IV immunoglobulins

ITP

ITP

splenomegaly

exclusion
splenomegalo

lyphadenopathy
platelet

ITP

splenomegaly
splenomegaly
ITP

Thromboasthenia
Platelets

function
VWBF

function

defect

Thromboasthenia

glycoptn recptor

Platelets

adhesions
adheiosn

deficeny
inhibition

congenitally

endothelium

toxins

VWB disease
RenalFailur

VWBF

failure

congenital or uremia
adhesion

Bernard

release VWBF
congenitally

congenitally

receptors

VWBF

platelet

thromboxane and adenosine

aggregations

aggregation

VWBF

receptors

aggregations

fibrin

2B

receptor

aggregations
fibrinogen

congenital afibrinogenia

diphosphate
Afibrinogenmia

fibrin

fibrinogen
congenitally

glanzman disease

1911

receptors

congenital

Dysphybrinogenima

receptors

congenital

receptor

Aspirin
antiplatlet

aggregation

fibrin

thromoxane A2

clopidogrel

ADP
angina

platelets
granules

afibrinogenima

BM

Tirofiban

angina and myocardial infarction

glanzman disease

3 adhesions

toxins prevent its release

glycoptn

defect

storage disease
secretions

granules

secretions
secreting stage

angina :D

granules

Thrombocytosis
primary ya secondry

Platelets

thrombocytosis

chronic myelocytic leukemia

polycythemia vera

primary
leukemia

essential hypertension
primary thrombocytosis
Platelets primary

essential thrombocytosis

Platelets

bleeding tendency

non functioning

bleeding tendency
hemorrhage hemolysis bonemarrow irritation

Platelets
non functioning

splenectomy

secondry
Platelets are function

thrombocytosis
ITP causes of asthenia

just causes

causes of thrombocytopenia causes of thrombocytosis

decr production

Platelets

destruction of platelet

Coagulation defect Hemophilia A

hemophilia a , b , parahemophilia,

congenital

congenital and acquired

coagulation
7 . 9 .11.13

Hemophilia A
VWB 1

factor 8 antihemophilic globulin

activate 7

7 activate

11

Platelets adhesion

< 11 activate

1
endothelim

12 intrinsic pathway

Liver
ca & factor 8

VWBF

antihemophilic globulin ,

liver

intrinsic

11
factor 8

disease

urine
antihemophilic globulin
Intrinsic pathway
males affected , females carrier

VWBF
hemophilia a

X linked

antihemophilic deficecny is hemophilia a

Clinical picture
joint

red , hot and tender

Ecchymosis , hematoma external hemorrhage *

joints
congenital
Hemorrhage

joint

ankylosis and fixation of joint

nerve

calcification

hematoma in muscles

cut of umbilical cord or circumcision >>

following trauma

Hemorrhage

family history

carrier

female

paternal uncle

maternal uncle

Investigations
ptt

intrinsic

Bleeding time normal

Clotting time prolonged
pt or ptt

pathway
211 51

1
mild

specific
01 25
moderate

5-25

sever

1-5

very severe

<1

DNa analysis

intrauterine

Treatment
Avoid truma

Avoid unnecessary operations

:D
hemophilic

31

15ml/kg

plasma

051

12

risk of hepatitis and

volume overload

1
051

15X30 ..

711
infections

factor 8 resistance

antibodies

antigen

active bleeding

factor 8 resistance

cryoperciptate
IV

room tempreture
=D

31

1
volume overload

volume

genetic engineering
bleeding

periceptate

cryo

crypoerciptate

hepatitis and aids and factor 8 resistance

thrombin

thrombin

compression

externally

thrombin

Thrombin

VonwilleBrand Disease
urine

factor 8 VWB

VWB disease
actually

platelet count normal

prolonged bleeding time

investigations

plasma and cryo

endothelium

ADH
MCQ
hemophilia A

Hematology

ptt prolonged

ADH

desmopressin

Hemophilia

VWB disease
7